The president of the Royal College of Surgeons berated NHS surgery yesterday as a "second-class service" so short of consultants, nurses and theatre space that dozens of district hospitals may have to be downgraded.
Professor Sir Peter Morris said hospital surgery would have to undergo a highly controversial reorganisation because the NHS needs nearly 2,000 more consultants. Some district hospitals would stop emergency surgery and major operations and concentrate on routine elective surgery for day patients. Only larger hospitals in major centres of population would offer acute surgery covering all specialties, including a 24-hour emergency service tied to a casualty department.
Sir Peter said difficult decisions on smaller hospitals would have to be made in two years because maintaining consultant and junior doctor cover would be impossible. Reorganisation would be politically sensitive. Labour lost its Wyre Forest seat at the election when Dr Richard Taylor, a retired consultant, was voted in because of protests about the downgrading of Kidderminster Hospital.
But a report by the royal college said that by 2010, England will require 2,000 more consultants to cope with increasing demands for surgery. "The capacity for safe surgery is frequently limited by lack of operating time, lack of high dependency and intensive care beds, shortages of skilled nursing staff, lack of elective surgical beds and lack of adequate equipment," it said.
Sir Peter said conditions had fallen behind many other countries and Britain had far fewer doctors per thousand people. "We have a second-rate service. We don't have enough surgeons. The infrastructure is disastrous in some places, there are not enough beds and elective surgery is almost at a standstill in some hospitals," he said.
"There are not enough operating theatres. There are shortages of anaesthetists mainly because they also have to cover so many hospitals it is difficult to provide the degree of service required. Many places are using old instruments. In America instruments are replaced every six months. [Here] we are lucky to get a new instrument within two or three years."
The report said emergency surgical admissions rise by almost 30 per cent a year in some urban areas. But most consultants retire at 60, recruits want to work more flexible patterns and the European working time directive has severely restricted the hours of junior staff. Sir Peter said some hospitals run illegal rotas for which trusts faced "very severe fines". Recruiting foreign consultants, and treating patients privately or overseas, were short-term fixes, he warned.
The college wants larger hospitals to provide all acute and emergency surgery and training for junior doctors. Surgeons would divide their time on elective surgery between the main hospital and smaller outlying ones. This would avoid duplication of resources, ensure junior doctors do not overwork, and give consultants time to train them in surgery.